340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-2097

Pharmacy Address

C/O PHARMACY DEPARTMENT
460 FAIRVIEW AVE
HUDSON, NY 12534

Pharmacy Comments

Approval Date

4/15/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Vincent J. Dingman III, Chief Financial Officer
(518) 828-7601 Ext: 8249

Contract Pharmacy Representative

Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719

Signed By Date

4/15/2014